Cementless THA for the Treatment of Osteonecrosis at 10-Year Follow-Up: Have We Improved Compared to Cemented THA?

Bedard, Nicholas A.; Callaghan, John J.; Liu, Steve S.; Greiner, Justin J.; Klaassen, Alison L.; Johnston, Richard C.

doi:10.1016/j.arth.2012.09.008

Cited by 63 publications

(28 citation statements)

References 26 publications

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“…[19][20][21] Similarly, others have reported improved results and lower rate of rTHA required for ON. 20,22,23 The present study found no significant differences in rTHA rates between the OA and ON groups, except for 1 year when ON had a small but significantly higher rTHA rate; however, because of the small number of patients who had revision THA within 30 days of their primary surgery, we question whether this was clinically relevant.…”

Section: Discussioncontrasting

confidence: 67%

Total Hip Arthroplasty Procedure Frequencies in Patients with Osteonecrosis versus Osteoarthritis

et al. 2017

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Atraumatic osteonecrosis (ON) of the hip is a debilitating disease. Multiple surgical treatment options are available ranging from joint-preserving procedures to total hip arthroplasty (THA), which is the most commonly performed treatment not only for ON but also for osteoarthritis (OA). Multiple studies have described the rates and trends of THA for OA and ON; however, none have directly compared the two. Therefore, the purpose of this study was to (1) determine the frequency and trends of joint replacement procedures; (2) compare these findings between the ON and OA populations; and (3) assess trends for revision total hip arthroplasty (rTHA). The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was evaluated for this study. All patients in this database obtained between 2008 and 2014 who had a diagnosis of hip ON or OA were identified using International Classification of Disease, 9th revision codes for hip ON and OA. This yielded 68,434 patients, including 3,816 patients with ON (mean age: 55 years, range: 18?90 years) and 64,618 patients with OA (mean age: 65 years, range: 18?90). The Cochran-Armitage test for trends was used to assess the differences in THA and rTHA rates over the study time period for each cohort. To compare whether these rates were different between ON and OA patients, we performed a Z-test between the groups for each year. The annual number of primary THA performed increased for both ON and OA between 2008 and 2014 (from 62 to 989 and from 1,011 to 19,004, respectively). The rate of primary THA significantly increased from 69 to 88% in ON patients. The rate of THAs for ON, out of all THAs performed for both ON and OA, decreased from 5.8% in 2008 to 4.9% in 2014. . The rate of rTHAs performed for both ON and OA decreased during this time (1.1?0.4% for ON and 0.4?0.2% for OA). ON patients had a significantly higher rate of rTHA only in 2011 and a higher rate of overall revisions. The rate of THA is increasing for both ON and OA, but the slope of the increase is higher for ON. This may indicate that orthopaedic surgeons are more confident in performing THA as newer devices and designs are being developed, allowing for better survivorship and outcomes. Additionally, although the overall rate of revision was higher in the ON cohort, at most annual time points, there was no significant difference. Further research is needed to determine why such trends exist.

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Section: Discussioncontrasting

confidence: 67%

Total Hip Arthroplasty Procedure Frequencies in Patients with Osteonecrosis versus Osteoarthritis

et al. 2017

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“…One study done before 1990 demonstrated that total hip arthroplasty in patients with osteonecrosis had a 17% revision rate at a mean of nine years, while total hip arthroplasties in studies done after 1990 had a 3% revision rate at a mean follow-up of six years 127 . Excellent survivorship at follow-up intervals of greater than ten years suggests that osteonecrosis does not lead to inferior outcomes with modern techniques and implants 273,278,279,285,[287][288][289]292,296,298 . Recent radiostereometric analysis studies have shown low wear rates and excellent survivorship rates at ten years postoperatively [305][306][307] .…”

Section: Total Hip Arthroplastymentioning

confidence: 98%

“…One concern with modern cementless prostheses is the potential failure of ingrowth due to osteonecrosis; however, this has not been found in recent studies. In 2013, one study demonstrated substantially lower rates of loosening in hips that had cementless total hip replacements than in hips that had cemented replacements 273 . The study with the longest follow-up period demonstrated a survivorship of 100% with aseptic loosening as the end point and 94% with all causes as the end point in sixty-four hips with cementless implants at a mean follow-up of sixteen years 308 .…”

Section: Total Hip Arthroplastymentioning

confidence: 99%

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

Mont

Cherian

Sierra

et al. 2015

The Journal of Bone and Joint Surgery

454

436

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➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.

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“…Likewise, cup fixation was encouraging with 14% of non-cemented acetabular cups requiring revision as a result of aseptic loosening after a minimum 15 year follow-up. Bedard et al [71] reported that, after a minimum 10 year follow-up, the reoperation rate for aseptic loosening was 2% and zero for noncemented femoral and acetabular components, respectively.…”

Section: Total Hip Arthroplastymentioning

confidence: 98%

Managing AVN following internal fixation: Treatment options and clinical results

Hoskinson

Morison

Shahrokhi

et al. 2015

Injury

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Cementless THA for the Treatment of Osteonecrosis at 10-Year Follow-Up: Have We Improved Compared to Cemented THA?

Cited by 63 publications

References 26 publications

Total Hip Arthroplasty Procedure Frequencies in Patients with Osteonecrosis versus Osteoarthritis

Total Hip Arthroplasty Procedure Frequencies in Patients with Osteonecrosis versus Osteoarthritis

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

Managing AVN following internal fixation: Treatment options and clinical results

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